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Int J Cardiol：使用鹅颈套圈轻松应对经桡动脉冠脉造影中的导管打结

2014-01-03 hleidoctor dxy

鹅颈套圈经桡动脉冠脉造影
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经桡动脉冠脉造影因其安全可行已被广泛接受。和经股动脉途径相比可显著减少穿刺部位相关的并发症发生率。但在某些情况下，经桡动脉送入导管时导管会在肱动脉内发生成环或扭曲成结。由于肱动脉直径较细，常规松解导管的操作方法可能无效。针对这种情况，我国南京医科大学第一附属医院心脏科的张定国等人使用鹅颈套圈装置成功解决了这一问题，并将临床经验进行了总结报道。相关的案例报道以“letter to the edito

经桡动脉冠脉造影因其安全可行已被广泛接受。和经股动脉途径相比可显著减少穿刺部位相关的并发症发生率。但在某些情况下，经桡动脉送入导管时导管会在肱动脉内发生成环或扭曲成结。由于肱动脉直径较细，常规松解导管的操作方法可能无效。


针对这种情况，我国南京医科大学第一附属医院心脏科的张定国等人使用鹅颈套圈装置成功解决了这一问题，并将临床经验进行了总结报道。相关的案例报道以“letter to the editor”的形式在线发表于2013年12月4日的《国际心血管病杂志》（International Journal of Cardiology）上。文中作者详细介绍了两例患者在经桡动脉冠脉造影时并发肱动脉内导管扭曲成结，随后通过使用Amplatz鹅颈套圈装置使问题成功解决，避免了计划外手术。

文章介绍的这两例患者均为经桡动脉冠脉造影过程中造影导管在肱动脉内严重扭曲致成结的情况。或由于导管到位困难引起极度扭曲所致，或由于锁骨下动脉以及主动脉过于迂曲所致。透视下均表现为肱动脉内导管扭曲成结而无法动弹，导丝亦无法通过。常规顺时针或逆时针旋转或轻度牵拉均无效，并且造成患者前壁严重疼痛。此时文章的作者使用了鹅颈套圈(Microvena, St. Paul, MN)装置使问题得到成功解决。首先穿刺右侧股动脉成功后送入6F JR3.5指引导管，经指引导管送入Amplatz鹅颈套圈，并在主动脉弓处抓住扭曲导管的顶端。向两个相反方向同时牵拉套圈和被套住的导管，这样在套圈的帮助下打折的导管被拉直。随后松开套圈，经0.35英寸导丝将打折的导管从肱动脉内成功撤出。


                        A.6-Fr JR3.5导管在右侧肱动脉内扭曲成环 B.套圈呈张开状准备套住打折的JR3.5导管顶端                        C.最终 JR3.5导管解除成环并在导丝送入后成功撤出。

冠脉造影中导管轻度扭曲成环的情况比较常见，多是导管过度扭曲的结果，特别是当锁骨下动脉存在扭曲时。通常向相反方向做轻柔旋转即可。有时可通过沿导管送入导丝，由导丝协助松解打折的地方。但对于复杂的扭曲成环病变则无法奏效。过去有学者建议经对侧股动脉送入第二根导管，使其穿过成环的地方协助松解，但这些方法要求导管扭曲成结不能太紧，故存在一定局限性。而Amplatz鹅颈套圈法则相对具有优势。套圈张开并穿过导管游离端后收紧，可以很容易的固定住导管。因此作者推荐对于导管扭曲成结过紧，采用常规方法无效时使用此法。此方法操作安全、简便，使患者免于接受计划外的外科干预。

原文出处：

Zhang D1, Jia E1, Chen J1, Xu L1, Yang Z1, Li C2.A simple approach for the reduction of knotted coronary catheters during transradial coronary angiography.Int J Cardiol. 2013 Dec 4. pii: S0167-5273(13)02118-9. doi: 10.1016/j.ijcard.2013.11.075. 


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    2014-04-11 wetgdt

    #经桡动脉#

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    2014-11-07 仁者大医

    #Cardiol#

    0

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    2014-11-15 h.y200607_23674427

    #打结#

    0

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    2014-01-05 12498aa2m63(暂无昵称)

    #桡动脉#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1931759, encodeId=09971931e595a, content=<a href='/topic/show?id=844be83226c' target=_blank style='color:#2F92EE;'>#经桡动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78322, encryptionId=844be83226c, topicName=经桡动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e34303, createdName=wetgdt, createdTime=Fri Apr 11 15:39:00 CST 2014, time=2014-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1781657, encodeId=d44c1e8165717, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Nov 07 21:39:00 CST 2014, time=2014-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688257, encodeId=bf7e168825e5d, content=<a href='/topic/show?id=7efe54649b2' target=_blank style='color:#2F92EE;'>#打结#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54649, encryptionId=7efe54649b2, topicName=打结)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a04028514764, createdName=h.y200607_23674427, createdTime=Sat Nov 15 11:39:00 CST 2014, time=2014-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1441082, encodeId=89e9144108240, content=<a href='/topic/show?id=81a3623569c' target=_blank style='color:#2F92EE;'>#桡动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62356, encryptionId=81a3623569c, topicName=桡动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae384789560, createdName=12498aa2m63(暂无昵称), createdTime=Sun Jan 05 02:39:00 CST 2014, time=2014-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447175, encodeId=8721144e17553, content=<a href='/topic/show?id=dd2f31009da' target=_blank style='color:#2F92EE;'>#冠脉造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31009, encryptionId=dd2f31009da, topicName=冠脉造影)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=l9h0OhA0BicNC4kpEUl4AeA&s=100&t=1587635346, createdBy=61865326685, createdName=李研东, createdTime=Sun Jan 05 02:39:00 CST 2014, time=2014-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493967, encodeId=4582149396e25, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Jan 05 02:39:00 CST 2014, time=2014-01-05, status=1, ipAttribution=)]
    2014-01-05 李研东

    #冠脉造影#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1931759, encodeId=09971931e595a, content=<a href='/topic/show?id=844be83226c' target=_blank style='color:#2F92EE;'>#经桡动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78322, encryptionId=844be83226c, topicName=经桡动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e34303, createdName=wetgdt, createdTime=Fri Apr 11 15:39:00 CST 2014, time=2014-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1781657, encodeId=d44c1e8165717, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Nov 07 21:39:00 CST 2014, time=2014-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688257, encodeId=bf7e168825e5d, content=<a href='/topic/show?id=7efe54649b2' target=_blank style='color:#2F92EE;'>#打结#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54649, encryptionId=7efe54649b2, topicName=打结)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a04028514764, createdName=h.y200607_23674427, createdTime=Sat Nov 15 11:39:00 CST 2014, time=2014-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1441082, encodeId=89e9144108240, content=<a href='/topic/show?id=81a3623569c' target=_blank style='color:#2F92EE;'>#桡动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62356, encryptionId=81a3623569c, topicName=桡动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae384789560, createdName=12498aa2m63(暂无昵称), createdTime=Sun Jan 05 02:39:00 CST 2014, time=2014-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447175, encodeId=8721144e17553, content=<a href='/topic/show?id=dd2f31009da' target=_blank style='color:#2F92EE;'>#冠脉造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31009, encryptionId=dd2f31009da, topicName=冠脉造影)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=l9h0OhA0BicNC4kpEUl4AeA&s=100&t=1587635346, createdBy=61865326685, createdName=李研东, createdTime=Sun Jan 05 02:39:00 CST 2014, time=2014-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493967, encodeId=4582149396e25, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Jan 05 02:39:00 CST 2014, time=2014-01-05, status=1, ipAttribution=)]
    2014-01-05 智者为医08

    #造影#

    0